NCHS Data Brief ■ No. 84 ■ January 2012
Home Births in the United States, 1990–2009
Marian F. MacDorman, Ph.D.; T.J. Mathews, M.S.; and Eugene Declercq, Ph.D.
• Afteradeclinefrom1990
to2004,thepercentageofU.S.
birthsthatoccurredathome
increasedby29%,from0.56%
ofbirthsin2004to0.72%in
2009.
• Fornon-Hispanicwhite
women,homebirthsincreased
by36%,from0.80%in2004
to1.09%in2009.About1
inevery90birthsfornonHispanicwhitewomenisnow
ahomebirth.Homebirthsare
lesscommonamongwomenof
otherracialorethnicgroups.
• Homebirthsaremore
commonamongwomenaged
35andover,andamongwomen
withseveralpreviouschildren.
• Homebirthshavealower
riskprofilethanhospitalbirths,
withfewerbirthstoteenagers
orunmarriedwomen,andwith
fewerpreterm,lowbirthweight,
andmultiplebirths.
• Thepercentageofhome
birthsin2009variedfrom
alowof0.2%ofbirthsin
LouisianaandtheDistrictof
Columbia,toahighof2.0%in
Oregonand2.6%inMontana.
LargechangesinbirthingpatternsintheUnitedStateshaveoccurredoverthe
pastcentury.In1900,almostallU.S.birthsoccurredoutsideahospital,the
vastmajorityofwhichoccurredathome(1).However,thisproportionfellto
44%by1940,andto1%by1969,whereitremainedthroughthe1980s(2,3).
The1989revisionoftheU.S.StandardCertificateofLiveBirthprovides
additionaldetailforout-of-hospitalbirths,andmakesitpossibletodistinguish
amongout-of-hospitalbirthsathome,inabirthingcenter,orotherspecified
location.HomebirthsarestillrareintheUnitedStates,comprisinglessthan
1%ofbirths,howevertheyhavebeenincreasingsince2004(3–5).Thisreport
examinesrecenttrendsandcharacteristicsofhomebirthsintheUnitedStates
from1990to2009,andcomparesselectedcharacteristicsofhomeandhospital
births.
Keywords: birth certificates • out-of-hospital birth
U.S. home births increased by 29% from 2004 to 2009.
ThepercentageofallU.S.birthsthatoccurredathomeincreasedfrom0.56%
in2004to0.72%in2009(Figure1).
Figure 1. Percentage of births occurring at home: United States, 1990–2009
1.2
1.0
0.8
Percent
Key findings
0.72
(29,650)
0.67
(27,678)
0.56
(23,150)
0.6
0.4
0.2
0.0
1990
1995
2000
Year
NOTE: Numbers of home births are shown in parentheses after percentages.
SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
2005
2009
NCHS Data Brief ■ No. 84 ■ January 2012
In 2009, there were 29,650 home births in the United States (representing 0.72% of births), the
highest level since data on this item began to be collected in 1989.
Previously, the percentage of home births had declined slowly from 0.67% of all U.S. births in
1990 to 0.56% in 2004.
In 2009, about 1 in 90 births to non-Hispanic white women were home
births.
There are large differences in the percentage of home births by maternal race and ethnicity, and
these differences have widened over time (Figure 2).
In 2009, the percentage of home births was three to five times higher for non-Hispanic white
women than for any other racial or ethnic group.
The percentage of home births to non-Hispanic white women increased by 14% from 1990 to
2004 and, more rapidly, by 36% from 2004 to 2009 (from 0.80% to 1.09%).
In contrast, from 1990 to 2004, the percentage of home births declined for American Indian
or Alaska Native (AIAN), Asian or Pacific Islander (API), Hispanic, and non-Hispanic black
women. From 2004 to 2009, the percentage of home births increased for API and Hispanic
women, and remained about the same for non-Hispanic black and AIAN women.
About 90% of the total increase in home births from 2004 to 2009 was due to the increase among
non-Hispanic white women.
Figure 2. Percentage of births occurring at home, by race and Hispanic origin of mother: United States, 1990–2009
1.2
1.0
Non-Hispanic white1
Percent
0.8
Non-Hispanic black1
0.6
0.4
American Indian
Hispanic
0.2
0.0
1990
1995
Asian or Pacific Islander
2000
Year
2005
2009
Data exclude New Hampshire in 1990–1992 and Oklahoma in 1990, as these states did not report Hispanic origin on their birth certificates for those years.
SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.
1
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NCHS Data Brief ■ No. 84 ■ January 2012
The percentage of home births was generally higher in the northwestern
and lower in the southeastern United States.
In 2009, Montana had the highest percentage of home births (2.55%), followed by Oregon
(1.96%) and Vermont (1.91%). Five additional states (Idaho, Pennsylvania, Utah, Washington,
and Wisconsin) had a percentage of home births of 1.50% or above (Figure 3).
In contrast, the percentage of home births was less than 0.50% for southeastern states from
Texas to North Carolina, as well as for Connecticut, Delaware, the District of Columbia, Illinois,
Massachusetts, Nebraska, New Jersey, Rhode Island, South Dakota, and West Virginia.
The increase in the percentage of home births from 2004 to 2009 was widespread and involved
selected states from every region of the country. Overall, 31 states had statistically significant
increases, and only two areas had statistically significant declines (see Figure 3 and associated
data table).
Figure 3. Percentage of births occurring at home, by state of residence, 2009
WA
MT
ME
ND
MN
OR
ID
WY
WI
SD
IA
PA
UT
IL
CO
CA
AZ
KS
OK
NM
NY
MI
NE
NV
VT
TX
IN
MO
OH
LA
VA
SC
AR
AL
GA
FL
AK
NJ
MD
DC
NC
TN
MS
MA
RI
DE
WV
KY
NH
CT
1.50%–2.59%
1.00%–1.49%
0.50%–0.99%
Less than 0.50%
U.S. average: 0.72%
HI
NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db84_tables.pdf.
SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.
Most home births are attended by midwives.
In 2009, 62% of home births were attended by midwives: 19% by certified nurse midwives and
43% by other midwives (such as certified professional midwives or direct-entry midwives).
Among hospital births, only 7% were attended by midwives (Figure 4).
Only 5% of home births were attended by physicians, and a previous study suggested that many
of these were unplanned home births (possibly involving emergency situations) (6). For hospital
births, 92% were attended by physicians.
For home births, 33% were reported as delivered by “other” attendants. “Other” may include, for
example, a family member or emergency medical technician (3,7). Among hospital births, less
than 1% of births had “other” attendants.
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NCHS Data Brief ■ No. 84 ■ January 2012
Figure 4. Percent distribution of home births, by type of birth attendant: United States, 2009
Physician
4.8%
Certified
nurse
midwife
19.5%
Other
32.9%
Other
midwife
42.9%
SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.
Compared with hospital births, home births are more common among older
married women with several previous children.
One in five home births were to women aged 35 and over, compared with 14% of hospital births
(Figure 5).
About one-half of home births were third- or higher-order births, compared with 28% of hospital
births.
About 84% of home births were to married women, compared with 59% of hospital births.
Figure 5. Percentage of home and hospital births with selected maternal characteristics: United States, 2009
Home
100
Hospital
84.0
Percent
80
58.7
60
50.1
40
20
0
20.8
27.9
14.2
Births to women aged
35 and over
Third- or higher-order births
SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.
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Births to married women
NCHS Data Brief ■ No. 84 ■ January 2012
Home births have a lower risk profile than hospital births.
The percentage of home births that were preterm was 6%, compared with 12% for hospital births
(Figure 6).
The percentage of home births that were low birthweight was 4%, compared with 8% for hospital
births.
Less than 1% of home births were multiple deliveries, compared with 3.5% of hospital births.
The lower risk profile of home births suggests that home birth attendants are selecting low-risk
women as candidates for home birth (5).
Figure 6. Percentage of home and hospital births with selected infant health characteristics: United States, 2009
Home
14
Hospital
12.2
12
Percent
10
8.2
8
6
5.8
4.2
4
2
0
3.5
0.9
Preterm
Low birthweight
Multiple birth
SOURCE: CDC/NCHS, birth certificate data from the National Vital Statistics System.
Summary
After 14 years of decline, the percentage of home births rose by 29% from 2004 to 2009, to the
point where it is at the highest level since data on this item began to be collected in 1989. The
overall increase in home births was driven mostly by a 36% increase for non-Hispanic white
women. About 1 out of every 90 births to non-Hispanic white women are now home births. The
percentage of home births for non-Hispanic white women was three to five times higher than for
any other racial or ethnic group.
Home births have a lower risk profile than hospital births, with fewer births to teenagers or
unmarried women, and with fewer preterm, low birthweight, and multiple births. The lower risk
profile of home compared with hospital births suggests that home birth attendants are selecting
low-risk women as candidates for home birth.
The increase in the percentage of home births from 2004 to 2009 was widespread and involved
selected states from every region of the country. The large variations in the percentage of
home births by state may be influenced by differences among states in laws pertaining to
midwifery practice or out-of-hospital birth (8,9), as well as by differences in the racial and ethnic
composition of state populations, as home births are more prevalent among non-Hispanic white
women (7).
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NCHS Data Brief ■ No. 84 ■ January 2012
Studies have suggested that most home births are intentional or planned home births, whereas
others are unintentional or unplanned, because of an emergency situation (i.e., precipitous labor,
labor complications, or unable to get to the hospital in time) (3,6). Although not representative of
all U.S. births (see “Data source and methods”), 87% of home births in a 26-state reporting area
(comprising 50% of U.S. births) were planned in 2009. For non-Hispanic white women, 93% of
home births were planned (10).
Women may prefer a home birth over a hospital birth for a variety of reasons, including a desire
for a low-intervention birth in a familiar environment surrounded by family and friends, and
cultural or religious concerns (9,11). Lack of transportation in rural areas and cost factors may
also play a role, as home births cost about one-third as much as hospital births (9,11,12).
Definitions
Home birth: A birth that takes place in a residence (home).
Percentage of home births: The number of home births divided by the total number of births
(regardless of place of delivery) times 100.
Preterm birth: Birth before 37 completed weeks of gestation.
Low birthweight: Infant weighing less than 2,500 grams at birth.
Data source and methods
This report is based on data from the National Vital Statistics System, Natality Data Files for
1990–2009. The Natality Data Files include data for all births occurring in the United States,
and include information on a wide range of maternal and infant demographic and health
characteristics (4). These data files are available for download at http://www.cdc.gov/nchs/
data_access/VitalStatsOnline.htm. Data may also be accessed through the interactive data tool,
VitalStats, at http://www.cdc.gov/nchs/VitalStats.htm.
Data on home birth began to be reported with the 1989 revision of the U.S. Standard Certificate
of Live Birth. Prior to 1989, births were reported as occurring in or out of the hospital, with no
specific category for home births.
The 2003 revision of the U.S. Standard Certificate of Live Birth added a data item on planning
status of home birth. However, due to the staggered implementation of the 2003 revision among
states, only 26 states (comprising 50% of U.S. births) reported data on planning status of home
birth in 2009 (10). The 26-state area is not representative of the overall U.S. population because it
is not a random sample of U.S. births.
About the authors
Marian F. MacDorman and T.J. Mathews are with the Centers for Disease Control and
Prevention’s National Center for Health Statistics, Division of Vital Statistics, Reproductive
Statistics Branch. Eugene Declercq is Professor, Department of Community Health Sciences,
Boston University School of Public Health.
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NCHS Data Brief ■ No. 84 ■ January 2012
References
1. Wertz RW, Wertz DC. Lying-in: A history of childbirth in America. New York: Schocken
Books. 1977.
2. Curtin SC, Park MM. Trends in the attendant, place, and timing of births, and in the use of
obstetric interventions: United States, 1989–97. National vital statistics reports; vol 47 no 27.
Hyattsville, MD: National Center for Health Statistics. 1999.
3. MacDorman MF, Menacker F, Declercq E. Trends and characteristics of home and other outof-hospital births in the United States, 1990–2006. National vital statistics reports; vol 58 no 11.
Hyattsville, MD: National Center for Health Statistics. 2010.
4. Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2009. National vital statistics
reports; vol 60 no 1. Hyattsville, MD: National Center for Health Statistics. 2011.
5. MacDorman MF, Declercq E, Mathews TJ. United States home births increase 20% from
2004 to 2008. Birth 38(3):185–90. 2011.
6. Declercq E, MacDorman MF, Menacker F, Stotland N. Characteristics of planned and
unplanned home births in 19 states. Obstet Gynecol 116(1):93–9. 2010.
7. MacDorman MF, Declercq E, Menacker F. Trends and characteristics of home births in the
United States by race and ethnicity, 1990–2006. Birth 38(1):17–23. 2011.
8. Midwives Alliance of North America. Direct-entry midwifery state-by-state legal status.
Available from: http://mana.org/statechart.html.
9. Declercq ER, Stotland N. Home birth. In: UpToDate, Rose BD (Ed). Waltham, MA:
UpToDate. 2009.
10. National Center for Health Statistics. VitalStats. Birth data for 2009. Available from: http://
www.cdc.gov/nchs/VitalStats.htm.
11. Boucher D, Bennett C, McFarlin B, Freeze R. Staying home to give birth: Why women in the
United States choose home birth. J Midwifery Womens Health 54(2):119–26. 2009.
12. Health Management Associates. Midwifery licensure and discipline program in Washington
State: Economic costs and benefits. 2007.
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Suggested citation
MacDorman MF, Mathews TJ, Declercq E.
Home births in the United States, 1990–
2009. NCHS data brief, no 84. Hyattsville,
MD: National Center for Health Statistics.
2012.
Copyright information
All material appearing in this report is in
the public domain and may be reproduced
or copied without permission; citation as to
source, however, is appreciated.
National Center for Health
Statistics
Edward J. Sondik, Ph.D., Director
Jennifer H. Madans, Ph.D., Associate
Director for Science
Division of Vital Statistics
Charles J. Rothwell, M.S., Director
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